Letter to the Editor by Cooper on Workplace Violence in Health Care: Recognized but not Regulated

Nurse Safety: Have We Addressed the Risks?

March 15, 2005

by Janet Cooper in response to Workplace Violence in Health Care: Recognized but not Regulated by Kathleen M. McPhaul, PhD(c), RN, MPH; Jane A. Lipscomb, PhD, RN (September 30, 2004)

Dear Editor:

A 6 foot 4 inch tall 280 pound intoxicated patient strikes and kicks his experienced emergency department (ED) nurse (Distasio, 2002). A disgruntled family member kills a San Diego ED nurse and paramedic student (Worthington, 2000). A nurse is shot by her estranged husband while working in a clinic. A second nurse is killed as she tries to help her fatally wounded coworker (Gilmore-Hall, 2001). A nurse is thrown to the floor by her patient. A patient threatens his nurse with rape and murder. A nurse's aide is knocked unconscious by a patient (Rippon, 2000). These and other stories about workplace violence are frightening. The facts about workplace violence are startling:

  • Violence is the 2nd leading cause of death in the workplace (Keely, 2002)
  • Health care and social services workers have the highest rate of nonfatal assault injuries (Bureau of Labor Statistics [BLS], as cited in American Association of Critical Care Nurses [AACN], 2004)
  • Nurses are three times more likely to experience workplace violence than any other professional group (BLS, as cited in AACN)
  • Most violent acts are unreported (AACN)

McPhaul and Lipscomb accurately summarized the problem. The presence of agitated, demented individuals or individuals with a history of violent behavior, the absence of violence prevention programs and training, and staffing shortages magnified by increased patient acuity are factors that contribute to workplace violence.

The estimated costs of workplace violence are astounding. We must consider not only the direct cost of services or goods used in treating the results of violent acts, but also the legal cost; the cost of premature death, disability, or long-term care; the cost of reduced productivity and high-staff turnover; and, finally, the loss of human potential and capacity to be a productive member of society.

In 1999 the International Council of Nurses (ICN) "condemn[ed] all forms of abuse and violence against nursing personnel . . . [and called them] violations of nurses' rights to personal dignity and integrity" (p. 21). I believe that prevention of workplace violence requires an organizational and personal commitment that demands the development of an organizational climate of non-violence.

The development of a zero tolerance approach regarding violence is fundamental in maintaining a safe workplace. A workplace analysis, violence prevention and control policies, workplace security, employee training, proper staffing, and confidential reporting of incidents with follow-up resources are essential to implementing effective programs.

Nurses, too, have a personal responsibility to themselves and their profession to demand a culture where violence is not tolerated, to know their work environment and its hazards, to know and follow protocols, and to report unsafe conditions and acts of violence. We must all learn about the problem and the issues at hand, get involved with policy making, know the components of effective violence prevention programs, and demand actions from our employers. Articles such as the one offered by McPhaul and Lipscomb are central to raising the awareness of the complex problem of workplace violence while challenging nurses to take a lead in creating safer work environments. Becoming familiar with the American Nurses Association's (ANA) publication, Preventing Workplace Violence (2002), and the Center for Disease Control and Prevention (CDC) publication, Violence: Occupational Hazards in Hospitals (2002) and sharing the information will also work toward eliminating this occupational hazard.

Thomas Edison said: Opportunity is missed by most people because it is dressed in overalls, and looks like work. Not only will this opportunity look like work, it will be work. But it is work that nursing cannot avoid. This is an opportunity for nursing to become a champion in a most important cause. It will, indeed, be through nurses' collective actions that violence prevention and control measures will be adopted and a sick violent environment be healed.

Janet R. Cooper, RN, MSN
Assistant Professor
University of Mississippi School of Nursing,
Jackson, Mississippi


American Association of Critical Care Nurses (AACN). (2004). Workplace Violence Prevention. Aliso Viejo, CA: Author.

American Nurses Association (2002). Preventing workplace violence [Brochure]. Washington, DC: Author. Available: www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/workplaceviolence/ANAResources/PreventingWorkplaceViolence.aspx.

Center for Disease Control and Prevention. (2002). Violence: Occupational hazards in hospitals (DHHS NIOSH Publication No. 2002-101). Cincinnati, OH: Author. Available: www.cdc.gov/niosh/pdfs/2002-101.pdf.

Distasio, C. A. (2002). Protecting yourself from violence in the workplace. Nursing 2002, 32(6), 58-63.

Gilmore-Hall, A. (2001). Violence in the workplace: Are you prepared? American Journal of Nursing, 101(7), 55-56.

International Council of Nurses. (1999). Guidelines on coping with violence in the workplace. Geneva, Switzerland: Author.

Keely, B. R. (2002). Recognition and prevention of hospital violence. Dimensions of Critical Care Nursing, 21(6), 236-241.

Rippon, T. J. (2000). Aggression and violence in health care professionals. Journal of Advanced Nursing, 31(2), 452-460.

Worthington, K. (2000). Violence in the health care workplace. American Journal of Nursing 100(11), 69-70.